BELIEVE ACHIEVE. CHC51712 Diploma of Counselling

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1 BELIEVE ACHIEVE CHC51712 Diploma of Counselling RPL KIT ACN ABN PO Box 1742, Oxenford QLD 4210 PH: MB: EM: CHC51712 Diploma of Counselling Version

2 APPLICATION Self Assessment Questionnaire CHC51708 Diploma of Counseling Candidate Name: Date Completed: Please identify your level of experience in each competency. Unit Code Unit Title COMPULSORY UNITS CHCCM503C Develop, facilitate and monitor all aspects of case management CHCCS514B Recognise and respond to individuals at risk CHCCSL501A Work within a structured framework CHCCSL502A Apply specialist interpersonal and interview skills CHCCSL503B Facilitate the relationship CHCCSL504A Apply personality and development theories CHCCSL505A Apply learning theories in CHCCSL506A Apply therapies to address a range of client issues CHCCSL507B Support clients in decision-making processes CHCCSL508B Apply legal and ethical responsibilities in practice CHCCSL509A Reflect and improve upon skills CHCCSL512A Determine suitability of client for services HLTHIR403C Work effectively with culturally diverse clients and co-workers HLTOHS300A Contribute to OHS processes ELECTIVES CHCICS303A Support individual health and emotional well being CHCICS405A Facilitate groups for individual outcomes BSBCMN502A Manage Meetings Training I have performed these tasks Y/N Frequently Sometimes Never Candidate Signature: Date:

3 RPL APPLICATION FORM Applicant Details: 1. Occupation you are seeking recognition in 2 Personal Details Surname Preferred Title (Mr, Mrs, Ms, Miss) First Name/s Any other name used Home Address Postal address if different from above Telephone Numbers HM MB WK Date of Birth Gender MALE / FEMALE Age Are you a permanent Resident of YES / NO Australia 3 Current Employment Are you currently employed? YES / NO If Yes, in which occupation are you currently employed? Who is your current employer? 4. Armed Forces details (If Applicable) Branch of Service Trade classification on discharge 5. Further Training Have you undertaken any training courses related to the occupation applied for? If Yes What occupation were you trained in? Training completion Date (month, year) Country where you trained Name of course and institution (if applicable) 6. Is there any further YES / NO

4 information you wish to give in support of your application 7. Professional Referees (relevant to work situation) Name Position Organisation Phone Number Mobile Number Address Name Position Organisation Phone Number Mobile Number Address

5 APPLICANT EMPLOYMENT HISTORY FORM Name, Address and Phone number of Employers Period of Employment (DD/MM/YYYY) Position Held Full Time Part-time Casual Description of Major Duties From To

6 If you are including documents in your application, please provide a brief description below Document Description (e.g. resume, photos, awards etc) Office Use Only Assessor to use this section to align documents to specific units of competency and identify key questions for competency conversation Declaration I declare that the information contained in this application is true and correct and that all documents are genuine. Candidate Signature: Date

7 UNIT CHCCM503C Develop, facilitate and monitor all aspects of case management EVIDENCE CHECKLIST EVIDENCE PROVIDED Please tick what evidence you can provide and attach it to the application CHCCS514B Recognise and respond to individuals at risk CHCCSL501A Work within a structured framework CHCCSL502A Apply specialist interpersonal and interview skills CHCCSL503B Facilitate the relationship CHCCSL504A Apply personality and development theories

8 CHCCSL505A Apply learning theories in CHCCSL506A Apply therapies to address a range of client issues CHCCSL507B Support clients in decisionmaking processes CHCCSL508B Apply legal and ethical responsibilities in practice CHCCSL509A Reflect and improve upon skills CHCCSL512A Determine suitability of client for services HLTHIR403C Work effectively with culturally

9 diverse clients and coworkers HLTOHS300A Contribute to OHS processes CHCICS303A Support individual health and emotional well being CHCICS405B Facilitate groups for individual outcomes BSBCMN502A Manage Meetings